多黏菌素B对多重耐药革兰阴性细菌感染的疗效与肾毒性分析  

Efficacy and nephrotoxicity of high-dose polymyxin B in treatment of multidrug-resistant Gram-negative bacterial infections

作　　者：陈丽娟[1] 吴晓丽[1] 杨康群[1] 秦海艳 朱蕻潮 Chen Lijuan;Wu Xiaoli;Yang Kangqun;Qin Haiyan;Zhu Hongchao(Department of Pharmacy,the Affiliated Huaian First People′s Hospital of NanJing Medical University,Huai′an 223300,China;Department of Nuclear medicine,the Affiliated Huaian First People′s Hospital of Nanjing Medical University,Huai'an 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院临床药学室,223300 [2]南京医科大学附属淮安第一医院核医学科,223300

出　　处：《中华全科医师杂志》2021年第9期997-1002,共6页Chinese Journal of General Practitioners

摘　　要：目的观察高剂量多黏菌素B与标准剂量多黏菌素B为基础联合治疗方案对多重耐药革兰阴性细菌感染患者的疗效及其肾损伤发生情况。方法回顾性分析2018年1月至2020年12月南京医科大学附属淮安第一医院以多黏菌素B为基础的联合治疗方案治疗的90例多重耐药革兰阴性细菌感染患者临床资料。按多黏菌素B使用剂量分为高剂量组[多黏菌素B剂量≥2.50万U·kg?1·d?1,31例(34.4%)]和标准剂量组[多黏菌素B剂量<2.50万U·kg?1·d?1,59例(65.5%)],观察两组患者多黏菌素B的疗效、肾功能的变化及肾功能损伤发生情况,采用logistic回归分析发生急性肾损伤(AKI)的相关因素。结果高剂量组日均多黏菌素B剂量和疗程分别为(2.98±0.45)万U/kg和(9.16±4.15)d,标准剂量组分别为(1.73±0.35)万U/kg和(7.32±3.87)d,两组比较差异均有统计学意义(t=13.36,P<0.01;t=2.04,P=0.04);高剂量组有效率为83.9%(26/31),标准剂量组有效率为61.0%(36/59),两组比较差异有统计学意义(χ^(2)=4.95,P=0.03)。标准剂量组患者治疗前、后肌酐水平分别为55.00(37.00,92.47)和50.10(34.00,156.00)μmol/L,差异无统计学意义(Z=-1.78,P=0.07),45.8%(27/59)的患者发生AKI;高剂量组患者治疗前、后肌酐水平分别为69.40(47.00,94.70)和116.20(59.20,213.20)μmol/L,差异有统计学意义(Z=-2.99,P<0.01),67.7%(21/31)的患者在治疗期间发生AKI;两组AKI发生率比较差异有统计学意义(χ^(2)=3.94,P=0.04)。高剂量组30 d病死率为32.3%(10/31),因AKI死亡4例,标准剂量组30 d 病死率为49.2%(29/59),因AKI死亡10例,两组比较差异均无统计学意义(χ^(2)=2.36,P=0.12;χ^(2)=0.25,P=0.61)。logistic回归分析显示每日高剂量多黏菌素B(调整OR=2.662,95%CI 1.082~6.549,P=0.03)与AKI发生独立相关。结论多重耐药革兰阴性细菌感染患者使用高剂量多黏菌素B具有较高的有效率,AKI发生率显著升高。Objective To investigate the efficacy and nephrotoxicity of high-dosepolymyxin B(PMB)in treatment of patients with multidrug-resistant Gram-negative bacteria(MDR-GNB)infections.Methods Clinical data of 90 patients with MDR-GNB infections who admitted to the Affiliated Huaian First People′s Hospital from January 2018 to December 2020 were retrospectively analyzed.Thirty one patients receivedhigh-dose PMB(≥25000 U·kg⁻¹·d⁻¹)for treatment(high-dose group)and 59 patients received standard-dose PMB(<25000 U·kg⁻¹·d⁻¹)for treatment(control group).The curative effect and renal function of the two groups were compared.The factors related toacute kidney injury(AKI)were analyzed with logistic regression.Results The daily PMB dose and treatment course in high-dose group were(29800±4500)U/kg and(9.16±4.15)d,while those of the control group were(17300±3500)U/kg and(7.32±3.87)d(P<0.01).The effective rate of the high-dose group was higher than that of control group(83.9%vs.61.0%,χ²=4.95,P<0.05).The creatinine levels in high-dose group were increased significantly from 69.40(47.00,94.70)μmol/L before treatment to 116.20(59.20,213.20)μmol/L after treatment(Z=-2.99,P<0.01);while there were no significant changesin control group before and after treatment[55.00(37.00,92.47)μmol/L vs.50.10(34.00,156.00)μmol/L,Z=-1.78,P=0.78].The 30-day mortality rate in the high-dose group was 32.3%(10/31),that in the standard-dose group was 49.2%(29/59)(χ²=2.36,P=0.12).The AKI incidence rate in high-dose group was higher than that in standard-dose group[67.7%(21/31)vs.45.8%(27/59),χ²=3.94,P=0.04].There were 4 and 10 deaths due to AKI in the high-dose and standard-dose groups,respectively(χ²=0.25,P=0.61).Logistic regression analysis showed that daily high-dose PMB was independently associated with AKI(OR=2.662,95%CI:1.082-6.549,P=0.03).Conclusion Thehigh-dose PMB is effective in treatment of patients with multidrug-resistant Gram-negative bacteriainfections,but the incidence of AKI is also significantly increased.Th

关 键 词：多粘菌素B 多重耐药革兰阴性细菌 肾损伤 药物毒性 药效动力学 

分 类 号：R446.5[医药卫生—诊断学]